Rural America Welcomes Doctors From Abroad

Sitting between a hammered tin crucifix and a plastic icon of the Hindu god Mahavir, Deloise Blevins is feeling doubly blessed.

For the first time in seven years, the only pain she has is from the thin surgical scar on her abdomen. Pain used to keep her in bed some days--pain so bad it shot up into her shoulders and sent her to the emergency room.

“I was a very sick lady,” the 50-year-old woman says.

She had been to doctors in Lexington, 2 1/2 hours away, but they weren’t much help. They said she needed a $1,300 CAT scan, $600 of that to be paid upfront. But with no insurance, she and her husband, Earnest, a disabled coal miner, couldn’t pay. She would have to live with the pain.

That’s when Blevins learned about the free, once-a-month clinic in this two-stoplight Appalachian town. That’s when she met Dr. Chandra Varia.

The Indian-born physician quickly diagnosed Blevins with ovarian cysts and endometriosis. Varia performed a hysterectomy and even persuaded Blevins to kick her 1 1/2-pack-a-day smoking habit.

Diana Hamilton, Blevins’ daughter, has high praise for the doctor’s skills and her willingness to listen and care. “What she’s done for my mom, I thank the Lord for her,” she says. “We need more doctors like her.”

“Whether they’re foreign or American or whatever,” adds Earnest Blevins.

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Graduates of foreign medical schools make up about one-fifth of the medical residents in the United States, and their numbers have been rising: 26,763 in 1996 compared with 11,556 in 1988, according to the Council on Graduate Medical Education.

With a physician glut on the horizon, some in medicine are debating whether to limit the number of noncitizens training in this country. The council has recommended that Congress cut back special visas.

Although the idea of the visas was to train doctors to serve their own countries, many earn waivers to remain here by working in areas where physicians are in short supply.

Some 1,100 special visas were issued last year. That compares with 950 U.S.-trained physicians placed in underserved areas by the National Service Corps. One study found a greater proportion of foreign-trained physicians planted roots in these communities than did their U.S. counterparts.

When Varia, now 61, arrived in Appalachia, such debates did not exist.

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She comes from a well-to-do family in Jamnagar, India. Nearing the end of her obstetrics residency in New York, she came to eastern Kentucky to visit a friend in this town of 690 in the heart of coal country.

The friend took Varia to Our Lady of the Way Hospital, a 39-bed, not-for-profit facility then run by the Sisters of Charity of Cincinnati. On the spot, Sister Loretta, the hospital’s administrator, offered her a job.

The town seemed too small then. “I could hardly breathe,” she recalls. The hospital where she trained in New York “has more beds than the population of this town.”

Besides, Varia had a sweet offer on New York’s Long Island: Two partners, a home by the beach, flexible hours. But Sister Loretta wouldn’t take no for an answer. Varia decided to give Martin six months. That was 19 years ago.

“The first day I came and I worked almost 14 hours,” she says. “And I love it. People are so nice. Everybody appreciates me, even all the physicians. Every morning they ask me whether I need anything, [whether] I am happy or not. Because they all wanted to keep me.”

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Not all foreign doctors and indigenous patients take to each other so readily.

Consider this scene in a rural doctor’s office. It’s part of a play but it’s based on real-life community focus groups in southwest Virginia.

“Dr. Assibehmen,” says the patient, a local woman, “I . . . don’t think that these pills are really working for me. They say they’re for nausea, but I have a backache. (These foreign doctors, they never understand.) . . .”

Doctor: “What sorts of symptoms are you experiencing? Nausea? Headaches? Vomiting? Perhaps this time I can get some specifics. (These mountain people. I just can’t understand her.) I’m sorry. What did you say?”

Woman: “I just can’t understand him.”

Doctor: “Is she speaking English?”

Woman: “Is he speaking English?” . . .

Doctor: “You’re not very much like me.”

Woman: “You’re not very much like me.”

The author, Pamela Teaster, an assistant professor at Virginia Tech, says the play reflects a lack of familiarity with other cultures that’s typical of many out-of-the-way places.

But she adds: “I don’t think it’s so ingrained that nobody’s going to trust anybody because they’re foreign.”

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The cross-cultural learning process between doctor and patient is becoming more common.

The U.S. General Accounting Office found that foreign-trained physicians seeking visa waivers to work in underserved areas increased from 70 in 1990 to 1,300 in 1995.

It is hard to imagine where some areas would be without these transplants.

After a brief residency in southern Illinois, Dr. Rup Nagala, a native of Madras, India, wound up in Oakes, N.D., population 2,000. A committee made up of the mayor, a grocer and others recruited the family practitioner in 1978.

“I guess I saw the town in the summertime, so I was very impressed,” he says with a laugh.

In North Dakota, foreign-trained doctors comprise 40% of the primary-care physicians in doctor-shortage counties, according to a study by the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.

“They all want to service rural North Dakota,” says Mary Amundson of the University of North Dakota’s Center for Rural Health. Why? They know most local graduates aren’t interested, and so it’s a sure foothold in America.

“They don’t even know rural North Dakota,” she says. “I know where they want to be.”

Recruiting Nagala was like building a doctor factory. He and his wife, Vani, an internist, have opened seven rural clinics as satellites to the 28-bed Oakes Community Hospital. They have brought in five physicians from India, Sri Lanka and Jordan with specialties ranging from oncology to psychiatry. Three plan to stay beyond their visa commitments.

And the town could get another physician: Nagala notes his 14-year-old daughter wants to become a doctor and return to Oakes. That makes him proud.

“Because, you know, if she’s a graduate from this country,” he says, “she could go anywhere she wants to, theoretically.”

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Chandra Varia and her husband, Mehandra, a veterinarian, chose not to have children. But in 1993, they set up a $25,000 scholarship fund for the hundreds of children Chandra Varia delivered before quitting obstetrics in 1992. They also gave $100,000 to a local community college program that helps single mothers on welfare.

Since January, Varia has blocked out one day a month for her free clinic. She likes to limit it to 15 patients; 22 are signed up on a recent day.

“When they call, you cannot say ‘no,’ ” says Varia, who is darting from room to room in running shoes, a white lab coat over traditional Indian paisley-print dress.

American citizens now, the Varias have become part of the local landscape. He is on the board of Mountain Christian Academy, a private school. A nursing laboratory at the community college has been named for them.

They’ve even found that local foods, like corn bread and pinto beans, fit nicely into the vegetarian diet prescribed by their Jain faith.

“We are not leaving the mountains,” says Mehandra Varia. “We are hillbillies, and we are going to retire here. . . . We have never felt out of home here.”